3005 Pancreatitis: An Unusual Initial Presentation of Duodenal Adenocarcinoma

Abstract

INTRODUCTION: Duodenal adenocarcinoma is rare. The clinical presentation is often nonspecific, and the diagnosis is made incidentally. We present a case of a 73 year old female presenting with pancreatitis, who was subsequently found to have duodenal adenocarcinoma. CASE DESCRIPTION/METHODS: 73 year old african american woman with hypertension presented with persistent nausea and vomiting of two weeks associated with burning epigastric pain and ten pound weight loss. She was previously treated for dyspepsia without improvement. She denied alcohol or non-steroidal use. She reports use of chewing tobacco. She denied fever, hematemesis, melena, hematochezia, or change in bowel habits. On physical examination, she was hypotensive and tachycardic. She had dry mucous membranes and delayed skin turgor. Laboratory examination revealed an unremarkable complete blood count. Comprehensive metabolic panel was remarkable for hypokalemia of 2.8 mEq/L, bicarbonate of 37 mEq/L, elevated creatinine of 1.23 mg/dL, elevated alanine aminotransferase of 58 U/L, and an elevated lipase of 369 U/L. Due to persistent abdominal symptoms, computed tomography of the abdomen and pelvis with contrast was performed, which was suggestive of pancreatitis or duodenitis. Patient was admitted for presumed pancreatitis. Intravenous fluids and antiemetics were initiated. Electrolytes were repleted. Right upper quadrant ultrasound and magnetic resonance cholangiopancreatography was without evidence of gallstones, cholecystitis, or biliary obstruction. Esophagogastroduodenoscopy and subsequent endoscopic ultrasound was performed and demonstrated diffuse moderately congested mucosa and an ulcerated mucosa with moderate stenosis found in the third portion of the duodenum. Biopsies were taken, which later revealed adenocarcinoma. Patient was started on total parenteral nutrition and followed-up with surgical oncology. DISCUSSION: Considering the rarity of duodenal adenocarcinoma, an early diagnosis is crucial. Clinicians should be aware of the nonspecific clinical and laboratory presentation, such as in our patient who presented with pancreatitis. A higher degree of suspicion and thorough investigation can lead to prompt diagnosis and earlier management and treatment.